Incessant overdose calls and multiple drug deaths during shifts are taking a serious toll on the mental health of B.C. paramedics, according to their union.

Bob Parkinson, director of health and wellness for the Ambulance Paramedics and Emergency Dispatchers of B.C., said even before the current fentanyl-related overdose crisis, paramedics were feeling strained while responding daily to life-and-death situations.

“We’re already an over-stressed workforce with little or no support, and we are seeing more and more effects of this,” he said. “We’re getting to the point that it’s becoming a crisis and this fentanyl stuff is just adding to it.”

With an overdose crisis across the province, paramedics in small communities are responding to calls and reviving friends’ kids or handling multiple overdoses involving casual drug users at parties, Parkinson said.

Paramedics aren’t able to respond as quickly to non-life-threatening calls and are arriving to find upset patients and family members.

Parkinson said depression and anxiety are the most common mental-health issues among paramedics, but some are dealing with post-traumatic stress disorder or struggling with family problems and their own addiction issues. He’s worried the workforce will lose quality women and men.

“You know how we cope as a first responder or a paramedic or a dispatcher — we go ’til we break, and then it’s too late,” he said.

Both Parkinson and Bronwyn Barter, president of the union, are pleading for more resource support and for government to quickly respond to an ORH report recommending an increase in B.C. Emergency Health Services’s fleet size.

“We need the public to support us and push our politicians and policy-makers to deal with this,” Parkinson said.

Barter said paramedics are accustomed to responding to life-and-death situations but the overdose crisis has changed the nature of their work.

“They’re basically going from call to call and they’re not even processing what they’re going through,” she said. “It’s just getting worse and, on top of that, we had resource issues prior to the fentanyl crisis being declared back in April.”

Distressed paramedics have access to an employee assistance program (EAP) hotline and can seek support from WorkSafeBC, but Barter said she’s heard this “isn’t enough” from those working on the front line.

“I have no doubt the employer thinks that they’re doing enough, but really a lot of the paramedics that call the EAP line just aren’t getting the results that they need,” she said.

Barter said paramedics have told her, “We don’t have any downtime to even process what we just saw,” while working overtime, on their days off and with no breaks during 12-hour shifts.

“It’s just literally one call after the other,” she said. “It’s getting close to the breaking point.”

On Nov. 26 the provincial government announced $5 million in funding for B.C. EHS to support paramedics and dispatchers during the overdose crisis.

The injection of cash was used for such measures as putting medical-support units in high-overdose locations, providing paramedics with bicycles and ATVs, and bolstering supervisory support to assist with triaging.

Linda Lupini, president of the B.C. Emergency Health Services, said the overdose crisis’s impact on B.C.’s paramedics is “absolutely a concern” for her organization.

“This kind of work is really difficult,” she said. “Just the repeated, cumulative stress of being in a pressure situation over and over again where you’re really having minutes to save a life is very difficult.”

Lupini said BCEHS implemented a comprehensive program for critical-incident stress management before the crisis, which led to 87 on-call peers being trained to help fellow paramedics deal with stressors.

In response to the crisis, managers have been visiting paramedics to check in on their mental health.

“They’re making sure they’re OK, they’re being a little more proactive about asking them whether they’re tired, whether they want to continue working, whether they need to reach out to any of the peers,” said Lupini.

Paramedics and dispatchers showing signs of acute stress are referred to a counselling program and have access to 39 psychologists connected to the organization for trauma counselling.

And during the past two weeks as overdose calls have spiked, BCEHS has “overstaffed,” Lupini said, with five or six additional cars in the Lower Mainland, where 90 per cent of the overdose calls are received.

But Lupini said there needs to be a widespread shift in understanding about PTSD and that it’s not limited to a single, traumatic event but can also involve many less-traumatic but stressful injuries.

Lupini said 200 of the province’s 4,500 paramedics are currently going through counselling because of specific traumas.

She recognizes the vital work of all first responders during the crisis but said paramedics, dispatchers and call-takers need to be recognized for their role, too. “They are the unsung heroes of this crisis.”

Jennifer Leyen, director of special care services for WorkSafeBC, said the “cumulative impact” of the crisis on first responders also has her organization’s attention.

“When you go to a couple overdose situations, it may not be that difficult,” Leyen said. “But if you’re doing month after month of this? That’s where I’m concerned and our first responders who are doing this day in and day out, I believe that’s worrisome.”

WorkSafeBC can replace a paramedic’s wages after a claim is accepted, but also offers access to critical incident debriefings immediately following a traumatic event as well as counselling.

Leyen said legislation allows WorkSafeBC to accept claims when a worker experiences one or more traumatic events, such as a scene where multiple people have overdosed, or cumulative stressors, such as responding to multiple overdoses over time.

WorkSafeBC is experiencing a gradual increase in the number of claims for mental-health disorders and the vast majority of allowed claims are related to a paramedic who has gone to a trauma scene, she said.

Leyen said that because of more public discussion about mental health, WorkSafeBC has had access to a broader range of effective treatment programs, such as RPOT (resiliency over psychological trauma), where clients go daily for group work, education, exposure and one-on-one counselling.

“Paramedics have a larger number of claims,” Leyen said. “We are still allowing a far higher percentage than the general workers in the community, but it is a lower allow rate than fire or police.”

Last year, paramedics had 13 PTSD claims accepted, compared to four for police and two for firefighters. Parkinson believes these numbers tell little about the true rate of injury among first responders.

“Take those stats with a grain of salt,” he said. “With psychological injury — with the stigma and the lack of knowledge — we’re often well into the injury before we can identify it.”

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